HomeMy WebLinkAboutBuilding Permit # 3/30/2016 BUILDING PERMIT 0 %,oRTH
TOWN OF NORTH ANDOVERto
APPLICATION FOR PLAN EXAMINATION
Permit No#: � � � Date Received
Date Issued: US
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1 OR'TANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building AOne family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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SCRIPTIO
NOF WORK TO BE PERFORMED:
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Id tification- Please Type of Print Clear.,
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OWNER Name. .� � mr'��: �s;,, ` , ��' �.:�-. � Phone:'' °.
Address:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT. $12.00 PER 1000
$ .00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.:
.” Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,fund
�Signatureaf RgentJOwner Signature of contractor
NORTH
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BOARD OF HEALTH
P IT T Food/Kitchen
Septic System
THIS CERTIFIES THAT .............................. BUILDING INSPECTOR
............ ... . ....... .. .. ......... .. .. .. . .. .... ...............
C. .................. Foundation
has permission to erect .......................... buildings o ... ..... ......... ....
1b1 • % Rough
to be occupied as ... .. . . . . .. ... .... .. . . .... .. !! ..... Chimney
provided that the person accepting this permit shall in every resect conform to the terms of the cation Final
on file in this office, and to the provisions.of the Codes and By-Law relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. ffia
PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMITI E IN 6 MONTHS ELECTRICAL INSPECTOR
CONSTRUCTIONUNLESS STAR Rough
Service
........................... ....... : f :�..:�........... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Per it Required t® Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Federal 10 0 05-4465829
RISE Engineering RI Contractor Registration No 8108
r, g MA Contractor Registration No 120979
RI S RE A division uf'i'hieisch Engineering
ENGINEERING 60 Shnwvnlut knit N2,Canion.,,t1A 02021 CONTRACT
339-502-6335% FAX 339-302-6345
Page i
PROGRAM MIS CONTRACT IS EUTERED INTO 6ErwM RISE
CMA-HRS ENOtREERutG AND THE CUSTOMER FOR WORK AS
DESCRIBED BELOW
_......
.......... ....___`_ ......___. ..___ - _. _...... PHONE DATE WENT I< WORK ORDER
fCLSTDldER
Andrew Shealy (978)809-0736 03!02!2016 430247 00002
- __
j\�1j{/f
_
._. Is-
e1t.UN6 STREET
SERVICE STREET �✓...�" LST la
X46 Sutton Street
346 Sutton Street
aERvICE CITY STATE.ZIP DILUNO CITY.STATE,ZIP
North Andover,MA 0 1845 North Andover,MA 0 18,45 L j
,TOB DESCRIPTION
BARRIER:A Blower Door Test will 1101 be conducted al your home,due to the presensc of asbestos.
50.00
Alit SEALING:Provide labor and mutcriafs to scat areas ofyour home against wvastcful,excess air Icakage. 'This work will be
performed in concert with the use ofspecial tools and diagnostic tests to assure that your home will be left with a healthful level of
air exchange and indoor air quality.Materials to he used to seal your home can include caulks,foams and other products. Primary
areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows aree not generally
addressed)"this will require(12)working hours.A reduction in cubic feet per minute(cfm)of air infibration will occur,but the
actuat numbcr of cfm is not guaranteed.
At the completion ofthe w eatheriration work.and at no additional cost to the homcow ncr a final blower door and/or combustion
safely analysis will he conducted by the sub-contractor to ensure the safety of the indoor air quality.
S1,020.00
DAMMING:Provide labor and materials to install It 12"layer of R-38 unfaced fiberglass baits to(86)square feet for damming
purposes.
$17630
ATTIC FLAT:Provide labor and materials to install u 7"layer of it 25 Class I Cellulose added to(942)square feet ofopen attic r
space.
$574.60
SLOPES:Provide labor and materials to install a 6"layer of R 21 Class I Cellulose added to(1 fib)square feet of slope urea.
Wbmvcr possible baffles will be installed tir the entire length of cath bay to maintain ventilation space.
$312.48
KNEEWALLS:Provide labor and materials to install 2" FSK fitced semi-rigid fiberglass board insulation to(136)square feet of
knecwwTtl)arca.
$476.00
KNEEWALL FLOOR:Provide labor and materials to install 116"layer of dense packed R-22 Class I Cellulose added to(119)square
feet of kneewall floor.
$211.82
KNEEWALL FLOOR:Provide labor and materials to install an 81'layer of R-28 Class I Cellulose added to(119)square feet oropen
knccwall floor.
5149.94
ATTIC ACCESS:Provide labor and materials to insulate the back of(1)uttic hatch with 2"rigid 111crmax board.Weatherstrip the
perimeter.
560.00
A171C ACCESS:Provide labor and materials to insulate the back ofthe attic door With 2"rigid 111emtax b(>rd mrd seal the door's
edge with wwe mberstripping to restrict air leakage.
$147.82
VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with gable wall mounted flapper vent to exhaust
existing bathroom(an(s).
$118.75
Federal ID#05-0405629
RISE En ineerinRI Contractor Registration No 8186
g Na� MA Contractor Registration No 120979
WR- I S E A division orl'biclsch EnOncering
ENGINEERING' 6o shawalut Unit H2,Canton,MA 02021 CONTRACT
339-502-6335 FAX 339-502-6345
Page 2
.. PROGRANVI THIS CCnTRACT is ENTERED INTO OMVM RISE
CMA-Ill ES ENGINEERING AM THE CUSTogiat FOR WORK AS
DESCRIBED BELOW
CLIPJNT q YNDnM ORDER
__ ....... _. .. - -.,. .___... .. ... ....... -- PHONE GATE ',.
CUSTO ZR
Andrew Shealy (978)809-0736 03102/2416 430247 00002
_B0.LIUG STREET '..
SERVICE STREET
346 Sutton Street 346 Sutton Street
....SERVICE CITY.STATE,LP
BILLING CRY.STATE.ZIP
North Andover,MA 01845 North Andover, MA 01845
JOB DESCRIPTION
VE;i fi1)-Xl'lON:Provide labor and materials to install ventilation cbtUes in(50)rafter bays to maintain air iln
Slow)()
BASEi1 EN'r CEILING:Provide labor and materials to install(116)linear feet of R-19 unlaced fiberglass insulation to the Perimeter
of the basement ceiling at the house sill.
$203.00
BASEWNT DOOR,Provide labor and materials to insulate the buck of the basement door leading to the bulkhead with 2`rigid
board that meets the sections 11-31MA and 316.6 requirements ol'building code. Seal all edges and scars With rSK tape.
572.22
RISE Engineering will apply all applicable,eligible incealives to this contract. You will only he billed the Net amount. Currently,
for eligible measures,Columbia Gas offers 73%incentive,not to eseced 52,000 per calendar year,and an incentive of 100%for the
Air Scaling measures up to the first$580 and all additional S340 ifsavin_s arc justified by the auditor.
for the safety and health ofyour home's indoor air quality,we will he conducting a blower door diagnostic of the available air 1101",in
your home both berore the work is begun,and after Ile 1Ycalhcri7uton work is complete.We will also conduct n full assessment of
the combustion safety ofyour heeling system and water heater.this has at value of$90 and is at no cost to you. Tatat allONN-&Ie
wetuharPration incentive is$3.110. ,
$90.00
r.Y>.
Total: $3,712.93
Program Incentive: $3,062.20
Customer Total: $650.73
WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFTCATtOM FOR THE Surd OF
'"Six Hundred Fifty&731100 Dollars $650.73
UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERHND,CUSTomER AGREES TO RELIT AMOUNT DUE IN PULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY
UNPAID BALANCE APTER 7D DAYS.SEE REVERSE FOR lLBPORTA.NT INFORMATIONON GUARANTEES,RIGHTS OF RECISION,SCHEOULIt0.AND CONTRACTOR REGISTRATIOIL
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLAN PACES
AUTHOR NA tfi. .. E.Enginftd*9
r�NOTE:TNRS CONTRA(JT MAY BE Yt1TttDRAY.7N 8Y VS IF NOT EXECUTED iYiTHtii DATE OF ACCEPTANCE
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND COHOm0.NS ARE
3aDAYS. ASSPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE TO 00 T}&IYORX
The Commonwealth of Massachusetts
Print Farm
Department of Inclnstrial Accidents
Office of Investigations
1 Congr-ess Street, Suite 100
Boston, MA 02114-2017
rvww.mass.govAlia
Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation
Address: 110 Perimeter Rd _
City/State/Zip: Nashua NH 03063 Phone #: 603-324-1974
Are you an employer? Check the appropriate box: Type of project (required):
1 .❑ I am a employer with 100 4. ❑ 1 am a general contractor and 1 6. ❑ New cons'trtiction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner-
listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ F Uilding addition
[No workers' comp. insurance comp. insurance.'
required.]
5. We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] ' c. 152, §1(4), and we have no Weatherization
m
eployees. [No workers' 13.❑✓ Other
comp. insurance required.]
*Any applicant that checks box#1 nnrst also fill out the section below showing their workers'compensation policy inlbrmation.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. I I'the sub-contractors have employees.they mast provide their workers'comp.policy munber.
I anz an emplover that is providing workers'compensation insurance for my employees. Below is the polio,and job site
in formation.
Insurance Company Name: ACE American Insurance Company
Policy #or Self-ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016
x
m
8.
.lob Site Address _City/State/Zip: `"
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do It ere certzunder the pains and penalties ref pe�jury that the in rmatiion provided above is trice and correct.
_
z °
r
Si�7natule Date.
Phone#:603-324-1974
Official arse only. Do not write in this area, to he completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
D1Y
ft4.. �, DAT 0(61242015rrY)
C RTEFI ATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement-A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s)-
PRODUCER CONTACT
a
Aon Risk Services Central, NAME.
Inc. PHONE (866) 283-7122 Fox (800) 363-0105 m
Southfield NI Office (AIC.No.Ext). (AIC.No.)
3000 Town Center E-MPJL
Suite 3000 ADDRESO
S
S
Southfield r-11 48075 USA
INSURER(S)AFFORDING COVERAGE NAIC 9
INSURED INSURER A Old Republic Insurance Company 24147
TODBUild Coro_ ACE American Insurance Company 22667
260 Jimmy Ann Drive INSURER B: p y
Daytona Beach FL 32114 USA INSURER O. ACE Fire Underv/riiers Insurance Co. 20702 '..
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570058348882 REVISION NUMBER:
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
S - TYPE OF INSURANCE
LTR INS VJVD POLICY NUMBER M�DD/YYYY I(MM/DC)NYYY) LIMITS
A X I COMMERCIAL GENERALLLABILITY MV2Y304834 06/3D/201) Obl'301201b EACH OCCURRENCE 52,000,000
CLAIMS-MADEX❑OCCUR. DAMAGE O R-NEED 52,OOO,000
DAMAGE
Ee occurrence)
AAED EXP(Any one person) 325,ODO
PERSONAL S ADV INJURY 52,000,000 o,
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S4,000,000 m
X POLICY F—]PRO-
JECT LOC PP.ODUCTS-COMP/OPAGG 54,000,000
OTHER.: �
a
n
A AUTOMOBILE LIABILITY NIIT,B 304835 b6/30/203 5106/30/20161 COMBINED SINGLE LIMIT 55,000,000 �
(Ea a—d-'
ANY AUTO BODILY INJURY(Per person) O
ALL DVVNED SCHEDULED z
AUTOS AUTOS BODILY INJURY N
ea
X HIRED AUTOS X NON-OWNED PP.OPEP.TY DAIAAGE
AUTOS Per%—dent)
m
UMBRELLA LIAB OCCUR, EACH OCCURRENCE U
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED I P.ETENTION
B WORKERS COMPENSATION AND VJLRC48251553 06/30/2015 06/30/2016 PER 0TH-
EMPLOYERS-LIABILITY y` STATUTE ER
YIN All Other $tales
ANY PROPRIETOR r PARTNER,r EXECUTIVE E L E HCH ACCID"c NT SZ,OOO,GOO
C OFFICEPJMcMB'cFEY,CLUDED% � N/A SCFC4815190 06/30/7015 06/30/'016
(ALzndatory in NH) WI Only E L.DISEASE-EA EREPL OYEE S1,000,000
If yes,do—nbe under
DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY Lliltl7 Sl.0(10,000
€3
ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Porn rks Schedule.may be attached if more spac—required)
vidence OT Coverage A
►ter-'
R-J
RTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIP.ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS. '
Builder Servi CeS Gro Up, Inc. AUTHORIZED REPRESENTATIVE
A TopBUild Company
260 Jimmy Ann Drive
Daytona Beach FL 32114 USA
91988-2014 ACORD CORPORATION.All rights reserved.
%CORD 25(2D14/01) The ACORD name and logo are registered marks of ACORD
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0 Park 3'1aza - 5t,lite 5 17 0
Boston., Massachusetts 021
Honnae .1m.p over'sent Contl-Gctoi' Registratioll
Regisiration: 179 141
Type: Supplement Card
FxpirailGn' 612.`,,'2016
BUILDER SERVICES GRUMP, INC.
RICHARD SCHV,/ARTZ
116 PERIMETER RD
NASHUA, NH 03663
t pdate Address and return Card.'hark rcasott ftrr chant:.
Address Rvnely lil Fillolw mem lost ('ard
__.. ----Ol'i ce of Uonsuner..Affzir,eL Business Rt,_ Liccnsti C,r ret;i5ir<rticin valid for individul u:e unh
'. iGl, 1P�t'R�VEh9EP�TGGNTPCCTG%^ beft,re the expiraation date. li found return to:
Office of Consumer A;Tairs and ?iusiness Regulszirr:a
-Registration:
791,41 Type -'ot;, Park i'taza a :.e ;
Expiration: ai_5/201E Supplement�arG i os:an,%'fA i12i lc
UILD:P..SERVICES GROUP, INC.
ICHA.RD SCHvVf-.RTZ
50 jj%AfAY A.AiN DRIVE
AYTONIA BEACH, FL.,_,14
€ nclersefretz rt Not vnfid 51'ithout signolure
ILj i,'Eih1f tY SCHW ART1:
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tcsCricY[d To. C:SSL-IC-IrasUfafi4tn Gartfrrrrtnr
ilur'e fn possess a Current ed"i()rt of�t,e f4tassa_husarts
;,f•e 151Eildille,Code is Catase t0r f0VO CahGO C)f tht5 licrtEs(r.
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